Collapsing Focal Segmental Glomerulosclerosis and Acute Kidney Injury Associated With Chimeric Antigen Receptor T-Cell (CAR-T) Therapy : A Case Report

© 2021 The Authors..

Chimeric antigen receptor T (CAR-T) cell treatment is a rapidly emerging therapy for relapsed/refractory hematologic malignancies. Although cytokine release syndrome is a common complication, a concomitant development of biopsy-proven collapsing glomerulopathy and acute kidney injury (AKI) has not been described with CAR-T cell therapy. We report a man in his early 20s with relapsed/refractory pre-B-cell acute lymphoblastic leukemia and compensated liver cirrhosis who received 3 courses of CD19-directed CAR-T cells. After the third CAR-T cell therapy, he developed severe cytokine release syndrome accompanied by new onset of nephrotic syndrome and AKI. Cytokine release syndrome was treated with tocilizumab. His kidney biopsy showed collapsing glomerulopathy, glomerulitis, and interstitial nephritis along with complete podocyte foot-process effacement. Due to disease progression, he was subsequently treated with bispecific CD19-directed CD3 T-cell engager antibody, blinatumomab, during which he developed another episode of cytokine release syndrome with exacerbation of nephrotic-range proteinuria and his AKI progressed to stage 3 chronic kidney disease. Excess cytokine-induced podocyte and renal tubulointerstitial injury and/or "on-target off-tumor" direct renal cell toxicity are the probable mechanisms of kidney injury. Further such reports will increase our understanding of the pathophysiologic basis of kidney injury with CAR-T treatment.

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:3

Enthalten in:

Kidney medicine - 3(2021), 6 vom: 02. Nov., Seite 1086-1090

Sprache:

Englisch

Beteiligte Personen:

Acharya, Ratna [VerfasserIn]
Horn, Biljana [VerfasserIn]
Zeng, Xu [VerfasserIn]
Upadhyay, Kiran [VerfasserIn]

Links:

Volltext

Themen:

Acute kidney injury
Case Reports
Chimeric antigen receptor T cells
Collapsing FSGS
Cytokine release syndrome
Leukemia

Anmerkungen:

Date Revised 24.12.2021

published: Electronic-eCollection

Citation Status PubMed-not-MEDLINE

doi:

10.1016/j.xkme.2021.06.011

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM334749603